Transcript Drugs Courts - The Different Faces of Substance Abuse

Drug Courts: Background
Carl Leukefeld
Lexington, Kentucky
January 24, 2012
University of Kentucky
This presentation is supported by National Institute on Drug Abuse grants RO1-13076 & U01-16205.
History
Drugs, Crime & Courts
•State Civil Commitment
•Lexington and Ft Worth – Civil
Commitment to Treatment
•Mandated Treatment/TASC
•Drug Courts
Crime & Drugs
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Crime and drugs continue to be spotlighted
with safety concerns, politics, costs, and
media – Prescription Drugs and Meth
Controversy – “Legalize” vs. “Lock‘em up”
Over 2.1 million US adults are incarcerated
and about 4.8 million are on probation and
parole -- Prisons cost the US about $60
Billion a year
Conceptual Framework
(Predisposing Conditions)
Genetic
Clients
Psychological
Drug Court
Social
Spiritual
Outcomes
(Crime &
Drugs)
Evidence-Based Strategies
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On-going assessments for service
needs - DAST, MAST, ASI
Cognitive Behavioral approaches
Motivational Enhancements - SBIRT
Social Learning approaches - Skills
Training
Boosting Relationships – Courts,
Community, and CJ
(Leukefeld, Gullotta & Gregrich, 2012; Taxman, 2008)
What We Think We Know
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Drug abuse is Chronic and Relapsing
Case management can reduce crime
and drug use
Co-Occurring disorders are common
Women are increasing
Self-Help boosts treatment
Medications can be effective but are not as
widely used
Motivation enhancements, relapse
prevention, follow-up, and skills based
interventions can be effective
Drug Court Best Practices
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Assessment, engagement, and
motivation
Monitoring and “surveillance”
Immediate Sanctions
KENTUCKY DRUG COURT:
An Overview
Honorable Charles Hickman
Vice-Chief Regional Circuit Judge
Chief Circuit Judge
Shelby, Spencer, Anderson Counties
Connie Neal
General Manager
Administrative Office of the Courts
Department of Statewide Services
Division of Drug Court
Kentucky Drug Court
Mission:
To protect public safety and reduce the
recidivism rate of drug addicted
offenders through an integrated
approach that involves court
supervision, substance abuse treatment
services, education, employment and
personal accountability, resulting in
positive and long-lasting life changes.
WHAT IS DRUG COURT?
 Drug Court is a court-managed, drug
intervention treatment program
designed to provide a cost-effective
alternative to traditional case processing
which utilizes a team approach to the
problem of drug addition
OK, So What is a Drug
Court?
 Drug Court is an alternative sentencing
program authorized by the Kentucky
Supreme Court that targets non-violent
offenders whose criminal behaviors
stem from substance abuse.
 Drug Court uses a team approach
combining case management, judicial
oversight, treatment, drug testing,
incentives and sanctions.
HOW DOES SOMEONE GET
INTO THE PROGRAM?
Participants enter the program either
through diversion or through probation.
With the advent of Family Court,
entrance into Drug Court can now be
made through the judge’s power of
contempt.
DIVERSION
-limited to Class D felonies
-limited criminal history
-consent of prosecutors
-if successful completion of Drug Court,
the offense is dismissed
PROBATION
-nonviolent offense(s) and offense(s)
stem from drug abuse
-must be a probatable offense
-individual Drug Court teams can put
additional limits to those permitted in the
program
-can be immediately probated into the
program or can be in lieu of a probation
violation
CONTEMPT
-A judge orders someone to enter Drug
Court through Family Court. If the
person fails to obey the order of the
court, the judge can find the person in
contempt and order them to jail.
Through Family Court, the power of
contempt allows for jail sanctions or
residential treatment.
10 Key Components
1. Drug Court integrates alcohol and other
drug treatment services with justice
system case processing.
Drug court promotes recovery through a
coordinated response to offenders dependant
on alcohol and other drugs. Realization of
these goals requires a team approach
including cooperation and collaboration of
the Judges, prosecutors, defense counsel,
probation authorities, law enforcement,
treatment and other community agencies.
Coercion Works
Treatment does not need to be voluntary
to be effective. Strong motivation can
facilitate the treatment process.
Sanctions or enticements in the family,
employment setting, or criminal justice
system can significantly increase both
treatment entry and retention rates and
the success of drug treatment
interventions.
Retention
Remaining in treatment for an adequate period
of time is crucial for treatment effectiveness.
Research indicates that for most addicts, the
threshold of significant improvement is
reached at about 3 months. Additional
treatment can produce further progress
toward long-term recovery. Because people
often leave treatment early, programs should
include strategies to engage and keep them
in treatment.
2. Using a non-adversarial
approach, prosecution and defense
counsel promote public safety while
protecting participants’ due process
rights.
To facilitate an individual’s progress in
treatment, the prosecutor and defense
counsel must shed their traditional
adversarial roles and work together as part
of the team. Once a defendant is accepted
into the Drug Court program, the team’s
focus is on the participant’s recovery and
law-abiding behavior, not on the merits of
the pending case.
3. Eligible participants are identified
early and promptly placed in the Drug
Court Program.
Arrest can be a traumatic event in a
person’s life. It creates an immediate crisis
and can force substance-abusing behavior
into the open. The period immediately after
an arrest provides a critical window of
opportunity for intervening and introducing
the value of treatment. Judicial action, taken
immediately after the arrest capitalizes on
the crisis nature of the arrest and booking
process.
Rapid Access
Because individuals who are addicted to
drugs may be uncertain about entering
treatment, taking advantage of
opportunities when they are ready for
treatment is crucial. Potential treatment
applicants can be lost if treatment is not
immediately available or is not readily
accessible.
4. Drug Court provides access to a
continuum of alcohol, drug and other
related treatment and rehabilitation
services.
The process begins in the courtroom and continues
through the participant’s Drug Court involvement.
While primarily concerned with criminal activity and
substance abuse, the team also needs to ensure
that other issues such as mental illness, medical
problems, homelessness, educational deficits,
unemployment, etc. are addressed. If these issues
are not addressed, they could impact the
participant’s success and compliance in treatment.
Treatment
Phase I:
A minimum of 3 contacts per week
A minimum of 2 self-help
meetings per week
Phase II:
A minimum of 2 contacts per week
A minimum of 3 self-help meetings
per week
Phase III: A minimum of 1 contact per week
A minimum of 4 self-help meetings
per
week
Self Help and Drug
Addiction Treatment
 40% of people in recovery used 12
steps
 Complements and extends treatment
efforts
 Most commonly used models (AA & NA)
 Most treatment programs encourage
self help participation during and after
treatment.
5. Abstinence is monitored by frequent
alcohol and other drug testing,
including evenings and weekends.
Frequent and random court-ordered drug
testing is an essential tool for the participant
to use to assist him/her stay clean. An
accurate testing system is the most
objective and efficient way to establish a
framework for accountability and to gauge
each participant’s progress. Drug testing
makes the participant an active and involved
part of the treatment process rather than a
passive recipient of services.
Drug Testing
 Phase I:
 Phase II:
 Phase III:
Minimum, 3 times per week
Minimum, 2 times per week
Minimum, 1 time per week
Participants are tested randomly.
Required to call a toll free number daily
Given specific hours to comply
Purpose of Drug Testing
 Essential tool for participants to use to assist
them in staying clean
 The most objective and efficient way to
establish a framework for accountability and
to gauge each participant’s progress
 It makes the participant an active and
involved part of the treatment process
 Detection of relapse enables early
intervention
 Addiction thrives in secrecy, drug testing
helps to promote honesty in recovery
 Helps to gain support and trust from family,
employers and others
Relapse
 Opportunity to process and educate the
participant on the progression of the
disease
 Learned Behaviors
 Brain development stops when using
starts
 Habilitation vs. Rehabilitation
 Years of addiction most likely won’t be
overcome with one intervention
6. A coordinated strategy governs
Drug Court responses to participant’s
compliance.
Abstinence and public safety are the ultimate goals
of Drug Court, but many participants exhibit a
pattern of positive urine tests within the first months
of admission. Because addiction takes a long time
to develop and many factors contribute to addiction
and dependency, it is rare that an individual stops
using as soon as they begin treatment. Although it
is recognized that addicts have a tendency to
relapse, continued use is not condoned and a
coordinated strategy, including a continuum of
responses to each relapse or other issue of noncompliance are essential.
6. A coordinated strategy governs
Drug Court responses to participant’s
compliance. (continued)
Drug Court must reward cooperation as well
as respond to non-compliance. Small
rewards, such as praise from the Drug Court
judge and team, increased privileges, and
lessened restrictions have an important
effect on a participant’s sense of purpose
and accomplishment.
Graduated Sanctions and Incentives
 The ultimate goal is behavior change
 Basic behavior modification
 Sanctions impose natural and logical
consequences
 Incentives are a positive reaction to
positive behaviors
Sanctions
Addiction takes a long time to
develop and many factors
contribute to addiction and
dependency
We must respond to negative
behaviors and choices immediately
to affect behavior change
To Be Effective Sanctions Must Be:
 Predictable and Controllable
 Consistent
 Immediate
 Smart-minimal amount of punishment
 Graduated-intensity increases with
number and seriousness of incidences
of non-compliance
 Non-personal-No Anger
Punitive Sanctions
 Community Service
 Writing Assignments
 Home Incarceration
 Jail Incarceration
 Termination
Therapeutic Responses
 Increased treatment contacts or level of
care
 Increased urine drug screens
 Increased 12-step/self-help meetings
Program Incentives
 Phase Promotion
 Decreased Supervision
 Certificates/Plaques
 Graduation Ceremonies
 Conditional Discharge (probation)
 Dismissal of charges (diversion)
Incentives
 Behavior does not change by sanctions
alone, in fact, sanctions alone do more
harm than good. Punishment is more
effective when used with positive
reinforcement
 Those in reinforcement contingency
stayed longer in treatment
 Effects of punishment are transitorychange ends when punishment ends
Natural Incentives
 Re-establish trust
 Job with paycheck and benefits
 Increased self-worth
 Re-building of personal relationships
 Independence
 Freedom from active addiction
 Respect
7. Ongoing judicial interaction with
each Drug Court participant is
essential.
The judge is the leader of the team. Drug Court
requires judges to step beyond their traditionally
independent and objective arbiter roles and develop
new expertise. The structure of the Drug Court
allows for early and frequent judicial intervention. A
Drug Court judge must be prepared to encourage
appropriate behavior and discourage and sanction
inappropriate behavior. Ongoing judicial
supervision communicates to participants, often for
the first time, that someone in authority cares about
and is closely watching what they do.
Judicial Supervision
 Phase I:
 Phase II:
 Phase III:
1 time per week
Once every 2 weeks
1 time per month
Purpose
 Immediate response to both positive
and negative behaviors
 Immediate intervention
 Positive interaction with authority figures
 Promote team concept
8. Monitoring and evaluation
measure the achievement of program
goals and gauge effectiveness.
Coordinated management, monitoring, and
evaluation systems are fundamental to the effective
operation of a Drug Court. Since the Drug Court
concept is still fairly new, Drug Courts will
consistently be asked to demonstrate tangible
outcomes and cost-effectiveness and must have
systems in place for monitoring daily activities,
evaluating the quality and effectiveness of services
provided and producing longitudinal evaluations.
2004 UKCDAR Outcome Evaluation
Reduced Recidivism for
Drug Court Graduates
Convictions for Drug Court Graduates and
Control Group 1 and 2 years after graduation
70.0%
57.3%
60.0%
52.1%
50.0%
40.0%
Drug Court Graduate
30.0%
Control Group
20.0%
20.0%
13.5%
10.0%
0.0%
1 Yr After Graduation
2 Yrs After Graduation
From Inception to June 30, 2011
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Court Obligations Paid:
$3,365,704
Child Support Paid:
$2,926,324
Successful Completions:
4,589
Drug Free Babies:
719
9. Continuing interdisciplinary
education promotes effective Drug
Court planning, implementation, and
operation.
Interdisciplinary education exposes
criminal justice professionals to treatment
issues and treatment professionals to
criminal justice issues. It also develops a
shared understanding of the values, goals
and operating procedures of both the
criminal justice and treatment components.
Staffing
 Creates an atmosphere for ongoing
interdisciplinary education
 Promotes all team member’s
understanding of the information being
shared
Quarterly Meetings
The Drug Court team holds quarterly
meetings to discuss program issues not
discussed during staffing sessions,
evaluate current practices and
brainstorm for program enhancements.
10. Forging partnerships among
Drug Court, public agencies, and
community-based organizations
generates local support and
enhances program effectiveness.
Because of its unique position in the criminal justice
system, Drug Court is especially well suited to
develop coalitions among community-based service
organizations, public criminal justice agencies and
treatment delivery systems. Drug Court is a
partnership among organizations dedicated to a
coordinated and cooperative approach to the drugaddicted offender.
Community Partners
 Local Mental Health Boards
 Dept. of Vocational Rehabilitation
 Agency for Substance Abuse Policy
 Cabinet for Health and Family Services
 UNITE
 Office of Drug Control Policy